With the travel around the festive holidays, so many of you have been asking about how to help with hip pain driving. Many of us struggle with lower back pain driving, buttock pain driving, or pain around the hip joint driving. With a little bit of knowledge and a few strategies, there are many ways you can gain some relief from your hip pain driving.
In this blog we will look at:
- Possible reasons hip pain may occur while driving – we will look at each region of the hip and pelvis (the front of the hip, the outside of the hip, the buttock, and the groin) and consider the structures that might be causing your pain.
- Strategies to reduce pain experienced in each of these areas (the front of the hip, the outside of the hip, the buttock, and the groin).
- Other strategies you can implement to reduce your hip pain driving for example breaking distances, moving more, changes to the car, and seeking help.
What causes hip pain while driving.
There are a few reasons you might experience hip pain driving. In this section, we will look at each area around the hip and look at the possible causes of your hip pain driving and why this may occur.
Front of Hip Pain Driving
Some of the possible causes of pain in the front of this hip include:
- Hip osteoarthritis
- Hip labral tear
- Hip Dysplasia
- FAI – femoroacetabular impingement
- Hip Flexor Pain (including iliacus, psoas, rectus femoris) muscle, tendon or iliopsoas pain
Why pain may occur at the front of the hip while driving.
There are 2 main reasons pain occurs at the front of the hip from driving. The first is pressure from closing down the front of this hip. Sitting in a car seat, or indeed a bus seat, truck seat, or motorbike seat, requires that the hip is bent. When the hip is bent the thigh bone (femur) comes up towards the pelvis bone. The structures at the front of the hip are relatively compressed, or brought closer together, or impinged. Over time this closing down pressure can build up until the structures that are responsible for the pain, start to complain that they have had enough. Pain is the result!
The second reason pain at the front of the hip driving can occur is due to the activity of lifting the leg to move the foot on the pedals of the car. This can be due to the reason discussed in the paragraph above, that is, as you lift the leg, you cause compression of the structures at the front of the hip as you lift your leg into a more bent position.
Pain lifting the leg may also be a result of a hip flexor muscle issue. Your hip flexor muscles include your iliacus, psoas, and rectus femoris. The pain may be coming from within the muscle itself, as with a hip flexor muscle strain. The pain may also come from a hip flexor tendon issue, or be related to the iliopsoas bursa, a small pocket of fluid that sits within the area. Some of the hip flexor muscles also have an attachment partly with the hip joint structures. The repetitive motion of lifting the leg using these muscles may be placing forces on the hip joint resulting in pain.
Pain on the outside of the hip driving
Some of the possible causes of pain on the outside of this hip driving include:
- Gluteal Tendinopathy
- Greater Trochanteric Pain Syndrome
- Hip Osteoarthritis
- Hip Joint pathology
- Low back referred pain
- Trochanteric bursitis / hip bursitis
Why pain may occur over the outside of the hip driving
Sustained sitting can result in low back pain which in turn can refer to the outside of the hip. It may be that the position of sitting is a problem for the back. Or it may be that being in any position for a prolonged time, including sitting is the problem. Sitting is considered a “flexion” posture for the back. Lumbar disc issues may not like this very much. If the car allows a less upright back, more slouched type posture, this may further irritate the back, resulting in greater amounts of leg pain than felt.
Sitting is a more bent, or flexed position of the hip, meaning the thigh bone (femur) comes up closer to the trunk. Some hip joint issues, such as hip osteoarthritis, hip labral tears, FAI, and hip dysplasia can be irritated with this bent, or flexed, position. Although these typically result more in pain at the front of the hip, pain at the side of the hip can also occur
Greater trochanteric pain syndrome, gluteal tendinopathy, and trochanteric bursitis are different terms used for pain over the greater trochanter, the bone at the top of the outside of the thigh bone (femur). They involve possibly the gluteus medius muscle and tendon, the gluteus minimus muscle and tendon, and the trochanteric bursa. Sitting places these structures under more compression as they pass over the side of the hip. Sustained sitting can eventually result in pain, or pain when going to stand after sitting.
Bucket-scalloped seats, meaning car seats that wrap up around the hips at the sides can also put pressure on the outside of the hips. The car seat on this occasion can put direct pressure on the tendon, bone, and bursa at the side of the hip, resulting in pain.
Pain in the buttock while driving
Some of the possible causes of buttock pain driving include:
- Pain felt more in the upper buttock can be as a result of:
- Low back referred pain
- Sacroiliac (SIJ) pain
- Piriformis syndrome, deep gluteal syndrome, hip related sciatica
Pain felt more in the lower buttock can be as a result of:
- Proximal hamstring tendinopathy or high hamstring tendinopathy
- Deep gluteal syndrome, hip related sciatica
Why pain may occur in the buttock driving
The sitting position can place direct compression on structures within the buttock resulting in pain. The bent position used to sit may also result in irritation of structures, especially the low back. Having the leg straighter, either in its resting position on the ground, or as it pushes on the pedals can also increase the tension of the nerves, in particular the sciatic nerve, as it runs around the back of the hip in the buttock, and then down the back of the leg. Not only might you experience pain in the buttock but also into the back of the thigh and lower leg. Pins and needles or numbness may also be felt in the leg.
Pain in the groin driving
Some of the possible causes of pain in the groin driving include:
- Hip Joint issues
- Hip labral tear
- Hip Osteoarthritis
- Hip dysplasia
Why pain may occur in the groin driving
Pain felt in the groin driving is unlikely to be due to an adductor muscle or adductor tendon problem as these structures are usually not under any stress or strain driving. Problems relating to the hip joint, such as hip osteoarthritis, hip dysplasia, hip labral tears or FAI can all result in pain at the front of the hip, but also in pain in the groin. Similarly to pain at the front of the hip, sitting is a more flexed, bent position of the hip, which can place more load on the structures within the hip joint. This in turn can then result in pain felt in the groin.
Pain in the saddle region driving
Some of the possible causes of pain in the saddle region driving include:
- Pubic pain
- Coccyx (tail bone) pain
- Saddle area nerve related pain
- Pudendal neuralgia
Why pain may occur in the saddle region driving
Pain in the area between the legs can come from the nerves that run through the hip and pelvis. These nerves may be compressed as they run through the buttock to then turn and head forwards to the saddle region. There are other nerves that sit through the front of the hip which in turn can be compressed as they run through the front of the hip, due to the fact that the knee is sitting up closer to the front of your body. Standing on the other hand is usually pain free as the hip is in a more open position.
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How can you relieve hip pain driving
In this section, we will focus on strategies to relieve your hip pain while driving. We will look at each part of the hip and pelvic region and consider the reason why you are experiencing pain. From this, we will outline some easy strategies to help reduce and improve your hip pain driving.
How to relieve pain at the front of the hip driving
As we discussed in the section above, (LINK up) many of the structures that can be involved with your pain in the front of your hip when sitting, become painful because of the more bend position the hip is in when you sit. The first strategy is to try opening the angle up at the front of the hip (and having a slight bend instead of a larger bend) can provide enough relief that you are then pain-free while you sit. To do this raise the height of your hips relative to your knees. Many car seats now have the function to do this but if not use a simple form of cushioning such as the wedge cushion. Place the higher part of the wedge under your hips, and the lower part pointing towards the knees.
The second strategy to try is to open the angle at the front of the hips by slightly reclining your car seat. But be aware! This can also put more requirements on the muscles to work at the front of the hip to lift the leg if it is your pedal leg. This may, in some cases, further irritate, rather than help your condition.
A third strategy is for those who get pain lifting the leg when using the pedals. Try moving your seat slightly closer to the steering wheel (focusing on the center of the wheel). This means the leg is not so stretched out and is easier to lift. This strategy will usually work best in combination with strategy 1, lifting the hips higher in relation to the knees, possibly with a wedge cushion. Another option for this group is to use the cruise control if available, thus negating the need to keep your foot lifted on the accelerator pedal.
How to relieve pain at the outside of the hip while driving
Key to relieving pain at the outside of the hip due to gluteal tendinopathy / greater trochanteric pain syndrome / trochanteric bursitis is to have the angle at the front of the hips more open, that is, to have the knee further away from the rest of your body, preferably below the height of the hips.
The main strategy is to raise the back of the car seat slightly higher. If your car doesn’t allow this function, then using cushioning toward the back of the car seat can do a similar thing. Specific cushioning such as “The Wedge Cushion” are relatively inexpensive to buy and east to then transport to use on other chairs your sit on. You can read more HERE.
The second strategy is to combine this first strategy with slightly reclining your car seat. But this strategy should be implemented with care as reclining your seat can place pressure on other structures such as your lower back, which may in turn aggravate pain.
For those whose hip pain at the outside of the hip is due to the lower back, a wedge cushion may again help. Lifting the hips higher than the knees can help to place the lower back and pelvis in a position of more pain relief.
The wedge cushion will also help lift you out of the seat for those of you with bucket–scalloped seats. This means that the seat can no longer put direct pressure on the sore tendons, bone, or bursa at the side of the hip. Reducing this compression can provide good pain relief.
A low back support in your car may also help relieve back-related hip pain. The flo back is a great example of a better back support – these not only give support to the curve of your lower back, but they also help to maintain a more upright position by providing support to the sides of your trunk.
Moving your car seat slightly closer to the steering wheel is another way that might help reduce back-related hip pain.
How to relieve pain at the upper buttock driving
Drivers and passengers frequently experience upper buttock pain when in the car. Car seats tend to encourage you to sit back comfortably in a slightly more reclined position. Unfortunately, this can allow the pelvis to tilt slightly backward, the lower back wanting to flex or slump slightly. The result is a build-up of pressure from the car seat over the middle and upper buttock region. This pressure and position can irritate your low back, which in turn can refer pain in and around the hip and buttock region. The pressure can also aggravate the sciatic nerve, a thick nerve that runs through the back of the pelvis down into the back of the leg.
One strategy is to try to lift the hips a little higher relative to the knees to place pressure instead onto the sitting bones (or ischial tuberosities) of the lower buttock, the structures that are better designed for you to sit on! You can do this by lifting the back of your car seat higher if your car allows it, or by placing cushioning towards the back of the chair that will lift the hips. The wedge cushion is specifically designed to do this easier and more comfortably – click HERE to read more.
If the first strategy is not an option, the second strategy is to reduce the firmness of the car seat by sitting on a pressure-reducing cushion.This is less ideal as you will continue to put pressure on the painful structures, but it will help to improve the comfort of the car seat
The third option is to have your chair less reclined. A more reclined car chair position will likely allow more pressure on the mid to upper buttock region. By bringing your car seat more upright and maybe slightly closer to the wheel, the pressure will move from the upper buttock to the lower buttock, thus reducing your symptoms.
If you are experiencing pain, check out our course and see if it is suitable for you.
How to relieve pain in the lower buttock driving
The main aim when trying to relieve your lower buttock pain driving is to reduce pressure from the car seat on this area. There are a few strategies to try here.
A pressure relief cushion is designed with small egg carton-style pieces of foam that separate to accommodate the point of most pressure. These are ideally suited to reduce lower buttock pain which is most commonly caused by proximal hamstring tendinopathy (or high hamstring tendinopathy). The tendon pain is linked to compression of the tendon as it passes over its attachment at the top of the leg, the sitting bones (ischial tuberosities). On a Pressure Relief Cushion, these bone points sink in between the foam, removing the pressure from this point.
Another strategy is to incorporate the strategy above with reclining your seat slightly backward. This reduces the pressure on the lower buttock, instead placing it more on the middle to upper buttock. This strategy needs to be implemented with care. Placing pressure higher up on the buttock can result in irritation of other structures, including the sciatic nerve and the lower back.
For those with tailbone or coccyx-related pain, a coccyx cushion is worth its weight in gold. These are a wedge cushion that moves your weight forward off the tail-bone, but with the added extra of a U shape cut out from the back of the cushion to ensure almost no pressure is allowed to pass onto the tailbone area – click HERE to read more.
How to relieve pain in the groin driving
Groin pain is frequently linked to similar causes of pain at the front of the hip. Therefore the same strategies to reduce pain at the front of the hip apply to the groin – check out the section above on “How to relieve pain at the front of the hip driving” to learn more.
How to relieve pain in the saddle region driving
Allowing your weight to rest more on your sitting bones can help balance pressure off other structures in the back of the pelvis. A coccyx cushion is ideal for those with coccydynia. The cushion has an angle to take the pressure off the coccyx. It also has a cut-out area where the coccyx of the tailbone is to take pressure directly off this structure relieving pain. You can read more about and purchase a coccyx cushion by clicking HERE.
Pain felt only in the saddle area, possibly from nerve damage, which feels worse due to pressure from the chair might benefit from a “keyhole comfort cushion”. This cushion has the middle part of the cushion cut out to totally remove any pressure from the area in between the legs. Click HERE to read more.
Other strategies to reduce hip pain driving
Break your trip
Hip Pain driving is frequently felt on trips that are over long distances. So before you head out on a longer road trip, research how to break your journey into shorter distances, with regular stops where you can get out, move and take a short walk around, this is vital if you are on a long trip, and in a seated position for a long time.
Another key thing to do if on a trip for long periods of time is to keep changing your sitting position slightly the entire time you are driving, and adjusting your driver’s seat, and ensuring you have the correct position (as per the examples we covered above). For example, move a little closer to, or further from the steering wheel, put your seat slightly more upright, or recline it slightly further back.
Change your car
In addition to the tips above for when you are on a long drive, you could also try and cange from a manual transmission to an automatic car. Many people find their pain is linked to the clutch pedal leg. If this is the case, and if sitting as a passenger and not using the leg is pain-free, then maybe switching from a clutch to no clutch is something to seriously consider.
Consult with a physical therapist
If you are still struggling to find a way to reduce your pain driving then consult with a Hip Pain Professional (click here to find someone near you), such as a physical therapist (physiotherapist). They will ensure you have a correct diagnosis and that you are making the right adjustments in the car. They can do an assessment of you as you sit in your car to help ensure you are in the best position to reduce your pain while driving. They will also look to implement other treatment strategies, such as advice, education, exercise, and hands-on manual therapy, to help you on a journey of recovery.
Meet our Hip Pain Professionals – Health professionals that know hips
Check Out More You Can Read on Hip Pain Relief at HipPainHelp:
Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B., 2018. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. May 2;361:k1662. doi: 10.1136/bmj.k1662.
This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.
Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD is Practice Principal of Physiotec Physiotherapy, an Australian Sports Physiotherapist and Adjunct Senior Research Fellow at the University of Queensland, author and global educator.
Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.